USMLE Step 1 Journal: Reflections on my USMLE Step 1 experience

As of Thursday, April 27 at 5:00 pm I am officially done with the USMLE STEP 1 exam! It has been 2 months since my last post. In that post, I discussed in detail my study plans for the two months leading up to the exam. In today’s post, I am going to walk you through my USMLE Step 1 experience and what I actually ended up doing and why that differed from my initial study plans. I’ll also share some USMLE Step 1 test day tips I found to be most useful, and reflect on how I prepared for the physically grueling aspects of test day.

usmle step 1 experience

In my last post, just two short months before the exam, I discussed my dedicated Step 1 study plans for those remaining two months. I was going to finish skimming through and reviewing each section of First Aid and then do ~160 questions from the UWorld Qbank per day (resting/reviewing SketchyMedical videos on weekends) until my exam date. This did not happen. As the saying goes, “Man plans, God laughs.”

My original plans got derailed for two reasons.

  1. It took me longer to get through First Aid than I had planned, but I was okay taking that extra time. Going through First Aid in its entirety in four weeks was valuable to me because it allowed me to see the overlap between all the organ systems in a way that I could not when I went through them one at a time over the course of my 20-month preclinical curriculum.
  2. Most importantly, after I finished First Aid and started UWorld questions, I saw that I was consistently falling short in pharmacology and microbiology, especially virology/parasitology/mycology, which I foolishly did not spend nearly as much time on as the bacteria when I took my microbiology course. I decided to do something about these consistent shortcomings.

At first, I was nervous to change my original USMLE Step 1 study plan. I had spent time researching and building that study plan. I had done the math to see how many questions I needed to do per day to meet a certain goal. I had even put it in my calendar day by day, hour by hour. It made me nervous to change things after so much planning.

usmle step 1 review

But then I thought of that adage: “Work smarter, not harder.” I’m sure that doing weeks of UWorld questions would have been helpful. It was certainly what the majority of my classmates were doing, and for this reason, I felt a lot of pressure to do the same. But just doing practice questions was not going to improve my weakest areas. So at that point, I took two of the three weeks I had left before my test and devoted myself to watching SketchyMicro and SketchyPharm videos, particularly focusing on my weak areas.

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I went through Parasites and Fungi in SketchyMicro, and most of SketchyPharm for the first time. I also took significant time to review Virology, which I had blown through at the end of my microbiology course in MS1. I left out the bacteria portion because I already had a pretty good handle on them.

Before my two weeks of dedicated studying focusing on SketchyMicro and SketchyPharm, I had been consistently scoring around the 60th percentile on my UWorld question blocks. Unfortunately, the USMLE folks do not publish percentiles that correlate with their scores, but according to an online calculator I found (not sure how accurate it is), this correlates to about a 230 on the actual test. After spending two weeks focusing on the SketchyMedical videos I mentioned above, I took a 4-hour long UWorld practice test. This was the Monday before my Thursday test. My estimated score on that test was a 243, which was only 2 points shy of my target score of 245. The important point here is that after my time focusing on my weakest sections, my score went up by around 10-15 points.

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The next day, I reviewed the sketches I had gone over for the last two weeks to help them stick. On Wednesday, the day before my test, I took the day off and went to the movies, spent time outside in my garden, and had a great dinner with my family. I finished that day feeling refreshed and ready for my USMLE Step 1.

Test day was a blur. I woke up early, drove to a coffee shop near the testing center, and spent a little time warming up my brain by reading. I got to the testing center 45 minutes before my test’s start time and was able to start 30 minutes early. Here are some things I found particularly useful.

  • Pack a full lunch, lots of snacks, and plenty of water. I had trail mixes, apples, chocolate (I told myself I need it for quick energy boosts), and a solid lunch of veggies and rice. I snacked and drank a couple mouthfuls of water after every block of questions, which kept me hydrated and energized without having to desperately fly through the end of a test block so I could go to the bathroom. These snack breaks (aka chocolate breaks) also gave me something to look forward to at the end of each block.
  • When your eyes and brain won’t focus on a question, take 10 seconds to pull your eyes off the computer screen and stare at something far away. Let your mind wander. I pulled this tip out of a Kaplan MCAT prep book and it has served me well on many tests since. It gives your eyes a little time to relax and take a break from that way-too-close computer screen.
  • Try to get two full nights of sleep the two nights leading up to your test. Don’t stay up cramming! It is way better to sacrifice those few things you would retain from your cram session, and instead, give your brain the rest and energy it will need to work through all that information you’ve been storing up over the last few weeks.
  • Take a practice test a few days before your real test. This will help shift you from study mode to test mode. And most importantly, it will give you a measure of how you will do on the exam. That knowledge gave me a lot of peace of mind in those few days before my test. Alternatively, if you don’t perform as well as you would have liked on the practice test, it will give you a little motivation to keep working hard until the day before your test.
  • Take a break and recharge before your test day! Before the MCAT, I took a whole week before my test where I looked at nothing MCAT-related. I just tried to relax and forget about it for a little while. By the time I got to the test, it felt like getting to hang out with an old friend that I hadn’t seen in a while… Or perhaps more accurately: rematch an old enemy. Before the USMLE STEP 1 exam, I took a whole day off and did things I enjoyed. I would definitely do this again. It recharged my spirit and mind after so many weeks dedicated to studying.

It’s only been a couple weeks since my test, so I don’t have my score back yet. And though I am certainly anxious to get that score, I do feel some measure of peace about the test and the way I prepared for it. I am glad I took the time to focus on my weaknesses. The jump in my practice test scores showed the benefit of that. I am glad I took the time to recharge, and that I packed snacks, took a break after every question block, and slept well before my test. Everyone’s study schedule and test will be different because every person is different. Hopefully, sharing my experience and knowledge has given you a better idea what you need to do to perform at your best on test day.

Good luck, and feel free to leave any questions in the comments below.


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The Timeline of Medical School

timeline of medical school

Our guest blogger today is medical school blogger Carly from Doctors of Tomorrow!

Hi everyone! My name is Carly and I am a fourth year medical student at the University of Arkansas for Medical Sciences. I applied for residency in Pediatrics and, along with every other M4, am anxiously awaiting Match Day. Since my pre-med days, I have been blogging about my journey to becoming a physician on my site, Doctors of Tomorrow. When taking a break from medicine, I enjoy traveling, all things Disney (really, what Pediatrician doesn’t?), and spending time with my dog, Koda.

I am nearing graduation, and I wanted to take a look back on these whirlwind four years to give you a timeline of medical school and some perspective of what you can expect in MS1, MS2, MS3, and MS4!

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The Timeline of Medical School

You hold the envelope in your hand. Inside is a piece of paper that will determine what you will be doing for the next four years of your life. You muster up the courage to open it and quickly skim its contents for the one word you have been striving towards: ACCEPTED. Your breath catches in your throat as the first thought that jumps into your head is that this might be a mistake. You read the word again to make sure you saw it correctly. You did. Then, you scan your eyes toward the top of the page to check whether this letter was meant for someone else or if it is your name that is on the top. It is. You have been accepted into medical school. Congratulations!

Now what? What happens next? Do you even really know what happens in medical school? There are so many different aspects of medical school to keep track of – from rotations, to USMLE exams, to ultimately applying for residency. This post will highlight all the major events of medical school and when they all occur. Buckle up, it is quite the journey!

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MS1: August

You take a deep breath and walk into the doors of the auditorium for your first lecture. You are starting medical school. It can take a few days, or even weeks, to get accustomed to this change, not to mention the amount of coursework that you are suddenly responsible for. You will also be starting (gross) anatomy lab shortly after school starts. This is the first time where you really begin to feel like you are becoming a doctor. Soak it in, but also stay focused and learn as much as you can.

MS1: December

You have made it through the first semester. To be honest, you aren’t really sure how, but you did. Take the winter break to unwind, you deserve it. Make time to spend with family and friends, especially some friends outside of med school, people whom you may not have had much time to see in the past 4 months. Read a good book, something that is not a textbook, and enjoy the time off.

MS1: Summer

While, for some, it may have felt like the year flew by and for others it couldn’t have gone slower, it’s over and summer is here. This will be the only summer that has a good chunk of time where you don’t have to be studying for exams, so make the most of it. Relax as much as possible, travel someplace you’ve always wanted to go, or go on a mission trip. If you already have an idea of what kind of medicine you might like to specialize in, find a physician who does that type of work and shadow them. Volunteer some of your time to a free clinic and practice your history taking and physical exam skills. If you want to go into one of the more competitive specialties, then you might want to use this summer to get ahead and start doing some research and board prep.

MS2: August

School starts again. Time to get back at it and crush this year!

MS2: January

You have been doing your best, learning as much as you can from each course, which is the first layer of Step 1 studying. However, you will be taking the USMLE Step 1 exam in about 5 months, so it is time to starting thinking about how to tackle this mountain. Research study plans and decide what resources you are going to use. Are you going to take a dedicated Step 1 study course or develop your own plan? Are you going to study as a group or by yourself? Evaluate how you study best and develop a course of action that will help you succeed. Also, start looking at Step 1 exam dates and plan when and where you want to take the test. You will need to register for the Step 1 as early as possible if you are want one of the more popular dates, which are typically in the last couple weeks of June.  If needed, you can also reschedule your USMLE Step 1 exam date (there is a fee if you try to change it thirty or fewer days before the originally scheduled test date).

MS2: May

Second year is finished, so now it’s time to buckle down and start your dedicated Step 1 study period. Typically, this time ranges from 4-6 weeks and include about 8-12 hours of studying per day. If you have the time, take a few days after finishing the school year to just decompress. Do something fun and spend time with family and friends, then come back refreshed and ready to focus on studying. Since you have already developed your study plan, you don’t have to waste time now deciding on what you are going to do. A lot of the success of Step 1 comes from effective planning. There is a ton of material to go over and remember, so stick to your study plan and chip away at the information bit by bit.

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USMLE Step 1

With all that’s riding on this one exam, there are so many resources out there to help students study for Step 1. So many in fact, that I quickly found myself overwhelmed when trying to decide how I was going to study. Finally, I just had to pick what I thought would work best for me and stick to it. Here are the resources I ended up using:

  • First Aid for the USMLE Step 1: During my 5-week dedicated study period, I read through all of First Aid about 1.5 times. For the second pass, I mostly focused on my weak areas.
  • UWorld: With over 2000 questions, I probably spent most of my dedicated study time doing UWorld questions. Obviously, you have to know the material, but another huge part of doing well on Step 1 is being able to dissect through the questions. With huge vignette question stems, lab values, and sometimes 10 or more answer choices, this is not an easy task. Doing several blocks of UWorld questions every day was key to learning how to pick out the important information in the questions and get used to managing my time.
  • Practice USMLE Step 1 Tests: I took a total of 4 mock tests during my 5 weeks of intensive study. I took the 2 UWorld Self Assessments and 2 NBMEs. These are extremely helpful in knowing where you stand score-wise and what you need to keep working on. To get the most out of these tests, try to simulate the actual test day as much as possible. Bring the same snacks you are planning on bringing on the real test day and time your breaks to what it will be like at the real thing. This way, the actual test day will go much smoother because you know more of what to expect. Anything that helps reduce stress or unexpected surprises is key to being able to put more of your attention and energy on the test itself. I found the UWorld Self Assessments and the NBMEs (at least the two I took) to be very different from each other. I would recommend using both to be able to get a better variety of what to expect on the real thing.  Here is also an official sample of Step 1 questions.

sketchypharm workbook pdf

  • Other Resources: In addition to what’s mentioned above, I used SketchyMicro and Pathoma. I wanted to keep my resources simple to avoid being overwhelmed with so many ways to study. I picked these two because I knew microbiology and pathology were two areas I needed the most help (unfortunately SketchyPharm and SketchyPath were not out yet when I took Step 1). I also loved being able to mix up my study routine with these two video resources instead of having to read another textbook. It helped things stay interesting and kept me on task. I highly recommend them both!
  • SketchyPharm and SketchyPath were not yet released when I was studying for Step 1, but I definitely would have loved to use them too if they had been!
  • Other Tips:
    • Probably the biggest tip I have is to be ok with changing the way you’re studying if you know whatever you’re doing truly isn’t working. The only thing I regret from this experience was basically wasting a whole week of study time, because I didn’t want to admit that what I was doing wasn’t working for me. For the first week of my dedicated study prep, I started out by only reading First Aid and doing UWorld questions. I thought I was doing well because I was getting through First Aid so quickly. I didn’t even realize that I was not retaining the information at all. I took my first NBME at the end of that first week and was brought back to reality with a score that was not what I expected at all. I realized right then that something needed to change. So, I decided to bring out my trusty white board. Throughout first and second year, I used my white board to study, but with so much information, I thought it would take too much time to study this way for Step. I had to accept, though, that this was the only way I was going to be able to retain what I was reading. So, I started reading a section in First Aid then going over to my white board and trying to write down everything I remembered about that section. It really helped me solidify the information and realize what I wasn’t actually understanding. I only wish I had started using this method from the beginning of dedicated study prep.
    • “Smart Book”: Basically, a “smart book” is your own personal First Aid. It’s just a notebook where you write down any piece of information that you need to remember. Mine included equations that I kept forgetting, mnemonics, and key points that I needed to know in order to answer a UWorld question correctly. Then, every night, I would read through my smart book. Repetition was key for me! Eventually, I found myself remembering points from my smart book and was able to get more and more questions correct. I definitely recommend using a Smart Book to study for big exams in general, and especially USMLE exams.

Overall, Step 1 was rough but not the impossible feat that I was expecting. The key was dedication, effective study time, and periods of stepping back and taking a few moments for myself. Surviving those 5 weeks would not have been possible without support from friends and family. Sometimes, a good rant session with friends from my class while walking around the outside track was necessary to let out all the built up frustration. Then, I was able to feel much better and get back to the study grind.

MS2: June

Depending on your school and how much time you have dedicated to studying, you will probably be taking Step 1 sometime in June. Take the day before the exam to relax. No studying allowed. At this point, you aren’t going to learn and retain anything that will make a monumental difference on the exam. Trust that you have studied hard and done all that you can. Now, focus on preparing your mind and body for the marathon that will be exam day.

sketchypharm vitamin d

MS3: July

Whew, Step 1 is over! Now, it’s time to start concentrating on your third year clerkships, which will typically start in July.  For the most part (at least at most medical schools), your medical classroom education ends after MS2. Most clerkship lectures will be in hospitals, and you will only occasionally go back to campus in MS3 and MS4.

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MS3: January

Around January of your third year, it is important to think ahead and decide when you want to take USMLE Step 2 CS. Students typically take this exam in April-June of their third year or sometimes in July of their fourth year. Because USMLE Step 2 CS is only offered in five exam locations in the whole country, spots fill up super quickly. Schedule this exam several months in advance of when you would like to take it in order to get a spot. If you already know when you’d like to take USMLE Step 2 CK, go ahead and schedule this as well.

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Also, during this time of year, you will probably be scheduling courses and electives for fourth year. Think about what electives you would like to take and whether you are going to do an away rotation and begin applying for these. Remember that October-January of your fourth year will be interview season, so try not to schedule your busier rotations during this time if you can help it.

MS3: April-June

Take USMLE Step 2 CS. Most likely you will have to travel to a testing location, so be sure to take this into consideration when scheduling when to take the exam. If you didn’t go ahead and schedule Step 2 CK when you scheduled CS, do this now. Spots don’t fill up as quickly as CS since there are many more testing locations, but you might want to make sure to get a certain day that works best for you.

MS3/MS4: Summer

During the end of third year and into the first couple of months of fourth year is when students typically take USMLE Step 2 CK. Plan out 3-4 weeks or longer to study for USMLE Step 2 CK, depending on your rotation schedule and how much time you will have to dedicate to studying.

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MS4: July-August

In the first couple months of MS4, you will start planning to apply to residency programs. Decide who you would like to write your recommendation letters and ask them early. Mentors are busy and appreciate plenty of heads up to write a recommendation instead of just asking them the week before it’s due. Start writing your personal statement and updating your resume/CV early as well. Then, you will have plenty of time for editing and even asking your mentors to review these before submitting them. Many letter writers also want your CV and personal statement to reference when writing your letter, so having these ready will be important.

Also, go ahead and start researching programs you might want to apply to. Think about what type of program you see yourself thriving in and look up which ones meet these goals. Having at least a rough draft of what programs you will apply to in advance will make submitting your application that much easier and less time consuming.

MS4: September

Early September is when you can officially submit your ERAS application and apply for residency programs. The application will open sometime a few months before, so you can start entering in your information whenever you get a chance. Plus, having your CV and personal statement already finished will make this process much faster.

Although you can submit your ERAS application after the opening day, I would recommend submitting it as early as you can, preferably even the first day it is open. Many residency programs start sending out interview invitations as soon as they start receiving applications. So, if you wait to submit your application, there is a chance that they have already given out all their invites and you won’t even get the opportunity to show them how great you are.

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MS4: September-October

After submitting your ERAS application, you will start receiving interview invitations from programs. During this time, students are typically checking their emails every few seconds to be able to accept invitations quickly. Keep a calendar close by so you can see what dates you have available and don’t accidentally over book.

Here are my top tips and advice I learned from going through the Match process.

MS4: October-January

Residency interviews will run from October through January of your fourth year. If possible, try to schedule interviews strategically by location and time in order to save time and money on travel. Being able to travel around and visit so many different programs is fun, but can get pretty exhausting. Do whatever you can to make this process easier for you, so that you can be your best at every interview.

MS4: February

By this time in MS4, you have visited many different programs, met so many different people, and now it is time to decide which ones you liked best and see yourself training at. Sometime in mid to late February, you will submit your NRMP rank list, which basically is a list of programs you would be willing to train at in order of preference. The programs also make a list of the students they would like at their programs, and then the computer algorithm tries to pair up students with programs as best it can.

match day

MS4: March

Match Day! Whether you will just receive an email or your school plans a big reveal party, this is when you will find out exactly what program you matched with and where you will do your residency training.

MS4: March-May

You have matched into a program and have a job for next year, now it is time to relax and enjoy the rest of fourth year. No more Step exams, applications, interviews, or uncertainty of what will happen after you graduate from medical school. Now is the time to have fun and do the things that you might not have time for in residency. However, be sure to be invested in the rest of your rotations as well. It might be the last chance you will have to learn a lot of this material, especially if it is something outside of your specialty, so make the most of it. During this time, you will also be planning for residency. You will have to sign your contract, fill out paperwork for your program, and plan to move if your program is in a different city.

MS4: May

Graduation! It has been four years since you took a deep breath and walked into those auditorium doors for your first lecture. You have studied more than you ever thought possible, made so many sacrifices, developed friendships that will last forever, and had experiences with patients that you will never forget. Congratulations, you made it! You are a doctor!

MS4: June

After graduation, you will need to get everything ready to start residency. If needed, you will have to move and get established in a new city or even a new state. Make sure to have time to do something fun, because you probably won’t have time for it during residency. You will also have residency orientation at your program a week or two before actually starting.

After Graduation: July 1st

You take a deep breath and walk into the doors of the hospital on your first day of residency. “Good morning, Doctor”, you hear someone say. You think, “Oh, they were talking to me? That’s right, I am a Doctor.” The next adventure of your life starts now!

The Timeline of Medical School

Feel free to connect with Carly on Facebook, Instagram, and Twitter!

Update: Congratulations to Carly on matching into her first choice residency!  Cheers to the next adventure!



The Sunday Spin: futility of care

The Sunday Spin, Episode 9: “Heroes and Villains”
SMiLE by the Beach Boys

futility of care

I apologize for the cynicism of this week’s spin, but I feel like futility of care is an issue that is not adequately addressed in the medical community. Additionally, discussions of these topics can improve our delivery of compassionate and palliative care, so here goes…

Primum non nocere: “First, do no harm”

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As physicians, we strive to do what’s best for our patients and their families. This could range from providing every possible test and treatment to doing absolutely “nothing.” Well, at least it might appear that the team is doing “nothing.” Yet, in actuality, the team is providing compassionate care and support by refraining from additional harmful testing and treatments.

Now, I’m not advocating that we follow the thirteenth law of the House of God religiously, which states that “the delivery of medical care is to do as much nothing as possible.” But, there are a number of instances where allowing a patient’s disease to progress without medical intervention is the most humane thing a physician can do.

As a community, physicians are horrible at identifying futility and knowing when to compassionately withdraw care. Part of this sentiment stems from our own hubris and unwillingness to admit failure, further complicated by our fear of mortality. To add to this predicament, end-of-life discussions are challenging for families and physicians. It’s much easier for all parties involved to avoid these difficult conversations and live in delusional bliss, hoping for a miracle.

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We’ve all seen it: an unconscious patient on a ventilator with a dismal chance at recovery; meanwhile the family sits anxiously at the bedside noting every twitch and gasp, as if it were evidence of higher cortical function; every modest improvement in the labs, which are ultimately the result of medical intervention and not a reflection of the patient’s own homeostatic function. All the while, money pours into the intensive care unit, sustaining the alarms and hopes of recovery of the patient.

This goes on day after day (or sadly even month after month), until the patient “unexpectedly” takes a turn for the worst or someone finally takes the initiative to discuss prognosis with the family, at risk of becoming a villain in their eyes.

In Pediatrics, the most salient examples of futility of care come from the Neonatal Intensive Care Unit. Since the initiation of NICUs, just over 50 years ago, we have seen incredible advances in our care of premature and septic neonates. We are now able to keep babies as young as 23-24 weeks gestation, deemed “micro-premies,” alive and able to progress past a year of live. This isn’t to say that these babies are without sequelae… The younger the gestational age of the infant, the less likely they are to survive to go home from the NICU and the more likely they are to have long term consequences of their prematurity which affect every organ system of the body.

After caring for a number of “micro-premature” infants at three different Neonatal Intensive Care Units and later in the pediatric hospital setting, I have noticed that most families don’t realize the repercussions of the early delivery until their child faces the complications… I don’t think that this is the fault of the NICU Intensivists, it is difficult to counsel on the diverse complications faced by premature neonates. Furthermore, with all the medical jargon we throw at these families; it’s impossible to fully comprehend what the life of their neonate will look like!

Is there a solution to this predicament? Perhaps not…

However, I do feel that it is the responsibility of the intensivists and specialists to portray a realistic representation of the complications that “micro-premies” face prior to discharge from the NICU.

All to often, the NICU doctors are heralded as heroes by the families they cared for; while the primary physician is made out to be a villain as they provide the grim reality of long-term care of their infant, which will likely include follow up with multiple specialists, challenges with feeding, breathing difficulties, learning disabilities, and growth deficiencies. Not to mention, the risk of frequent hospitalizations for respiratory illnesses that other children overcome effortlessly.

Yes, the outcomes of these micro-premature infants are miraculous, but these miracles come at a significant cost both monetarily and emotionally to the family. There is no right answer in how to address these situations, however, I do feel there is room for improvement in our medical system in caring for these complex children. And the same could be said for end-of-life care in older patients as well.

Hopefully, this Spin has provided some perspective on the cost of medical care and at least provoked some thought about futility of care within our system. You certainly can’t put a cost on life, however we often neglect to acknowledge what is best for the patient and the families. And carrying on futile care, in my opinion, is not in the best interest of the patient nor the medical community. If this makes me a villain, so be it…

Sometimes the difference between a hero and a villain is just a matter of perspective.

With that, lets get to the music 😀

the beach boys good vibrations

The Beach Boys’ The Smile Sessions is one of the most renown albums that almost never was…

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SMiLE was recorded from 1966 to 1967, the follow up to their 1966 release of Pet Sounds ; primarily written by Brian Wilson and Van Dyke Park in a sandbox in Wilson’s living room. Long nights of recording and reportedly $2,000 worth of marijuana allowed for the music to unfold.
Despite being at the height of Wilson’s musical creativity, the SMiLE Sessions have also been deemed the downfall of Brian Wilson, as drug abuse and mental health issues took over (famously depicted in the film love&mercy). The Smile Sessions would lead to songs such as “Heroes and Villains,” “Good Vibrations,” “Our Prayer,” “Vega-Tables,” and “Surf’s Up;” many of which would debut on later albums and compilations.

SMiLE took the techniques pioneered with Pet Sounds to a whole new level! Orchestrating heavenly harmonies and splicing together distinctly different sections, SMiLE would give rise to musical innovations, such as “sampling.” The best example of these techniques are demonstrated by “Heroes and Villains,” the opening track and conglomeration of cantina-esque piano stylings with vocal instrumentations and bizarre sound effects. At first listen, the track feels like a hodgepodge of segments. However, with familiarity, the true beauty of the music unfolds… “Good Vibrations” was synthesized in a similar fashion and would become the band’s biggest single ever produced.

Frustrated with the poor reception of Pet Sounds and progress of the SMiLE Sessions, Brian Wilson ditched the effort and focused on releasing simplified versions of the tracks on Smiley Smile, late in 1967. Smiley Smile featured versions of “Heroes and Villains,” “Vegetables,” “Wonderful,” “Wind Chimes,” and “Good Vibrations.” Additional tracks from the sessions would be reformulated and released on later albums, 20/20 and Surf’s Up.

Much of the SMiLE Sessions would remain unknown to the general public until 2004, when Brian Wilson released Smile in 2004, a collection of new recordings with his own band. This collection would reach #13 on the Billboard Chart and remain on the chart for 17 weeks and win Brian Wilson his first Grammy. The album and concert series also perpetuated the release of the Smile Sessions as they were intended in 2011 with several outtakes and demos. This album should prove to brighten up the dreariest of rotations.


A Day in the Life of a Podiatric Medicine Student

Our guest blogger today is Braden, a Podiatric medicine student!  He’s here to share his experiences studying medicine from a podiatry perspective.

a day in the life of a podiatry student

Hello, my name is Braden and I am currently a second year Podiatry student. I hope that I can help those of you reading this come to know what it is like to be a Podiatric Medical Student

I’d like to lay some ground-work to help those out there who may have never heard of Podiatry.

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braden jenkins

 “What is Podiatry?”

Not to be confused with pediatrics, podiatric medicine is a specialized branch of medicine devoted to the study, diagnosis, and medical and surgical treatment of disorders of the foot, ankle and lower extremity. Podiatrists are uniquely qualified among medical professionals to treat diseases of the foot and ankle. Whether it is surgery, sports medicine, pediatrics, dermatology, wound care, biomechanics or diabetes, today’s podiatrist can treat the many diverse facets of foot care. Podiatrists can be the first to identify systemic diseases in patients, such as diabetes and vascular disease.

Today’s podiatrists:

  • Perform surgery
  • Perform reconstructive and microsurgeries
  • Administer sedation and anesthetics
  • Perform complete medical histories and physical examinations
  • Prescribe medications
  • Set fractures and treat sports-related injuries
  • Prescribe and fit orthotics, insoles, casts and prosthetics
  • Order and perform physical therapy
  • Take and interpret X-rays, ultrasound, MRI’s and other imaging studies
  • Work as valued members of a community’s health care team

“What are the qualifications of a Podiatrist?”

Doctors of podiatric medicine receive medical education and training in podiatric medical colleges, including four years of graduate education at one of nine podiatric medical colleges (at least within the U.S.) and three years of hospital-based residency and surgical training. All podiatric physicians and surgeons receive a DPM degree.

“How is Podiatry (D.P.M.) Different from M.D. and D.O.?”

There are many differences between the various doctorate degrees and their respected capacities, but I’d like to focus on the fundamentals. Like most other medical schools, the first two years of podiatry school are dedicated to the basic sciences of medicine, followed by a board exam (part 1) in the summer after your second year. In fact, there are a number of Universities where the podiatry students and D.O. students take the same fundamental science courses for the first two years until they both take their respected board exams. Outside of the basic sciences, podiatry students take a number of field specific classes, such as: Lower Extremity Anatomy (being the biggest), Lower Extremity Physical Diagnosis, Radiology, Biomechanics, and Podiatric Medicine and Surgery.

The other big difference is our board exams. After the first two years of medical school, instead of the USMLE or COMLEX, we take the APMLE Part 1 (American Podiatric Medical Licensing Exam). The biggest difference between the exams is the emphasis on Lower Extremity Anatomy (for obvious reasons) and unlike the USMLE Step 1, there is no behavioral science section.

The APMLE Part 1 exam samples seven basic science disciplines:

  • Lower Extremity Anatomy (25%)
  • Microbiology & Immunology (15%)
  • Pharmacology (15%)
  • General Anatomy (13%)
  • Physiology (13%)
  • Pathology (12%)
  • Biochemistry (7%)


Currently, I am half way through my 2nd year at Kent State University, College of Podiatric Medicine in Independence, Ohio. Our beautiful campus is about 10 miles outside of Cleveland on a 27-acre location that cultivates an excellent learning environment. Our facilities are extremely nice and I feel blessed to have this opportunity to become a Doctor of Podiatric Medicine.

kent state college of podiatric medicine

I am originally from Idaho Falls, Idaho, and I have been married to my beautiful wife for almost 5 years and we have two beautiful children, ages 3 and 1. There are many reasons why I chose to go into medicine and into podiatry specifically, but my wife and kids are my number one reason. They are my driving force and motivation to keep doing my best in school and to better myself as a father, husband and future physician. I could not be doing this without them.

Growing up, my mom was the head surgical nurse for a local Podiatrist, so whenever I got the chance, I would shadow him in surgery. Throughout the many years shadowing him in his office and in surgery, I have grown to love the profession and it is through these experiences that I chose to go into Podiatry.

A Day in the Life of a Podiatric Medicine Student


For some, living in Ohio can be a nightmare with all of the snow and trying to get to school on time with the slick roads in the winter but for me, I’m used to cold and snow.  I should probably be a little more grateful for my 10-minute commute to school every day but even still, the traffic is the biggest thing that gets on my nerves. Being winter time, it’s still dark outside when I leave home and sometimes I start to wonder if the sun really exists anymore.

I try to get to school around 7:00am every day to study for an hour before classes start at 8:00. I’ll use this time to catch up on my course material if needed, but mostly I use it to study for boards with SketchyMedical and First Aid. If I have Pharmacology that day, I’ll watch the SketchyPharm video that goes along with our lecture. If I have Pathology that day, I’ll watch a Pathoma video that coincides with the day’s lecture and look over the daily case problem that we will be presenting; our professor likes to pimp you at random so it’s always best to be prepared (this was before SketchyPath).


After Pathology, we dive into my favorite class: Podiatric Surgery. This introductory course is to provide us with a broad foundation of general knowledge for perioperative management and core surgical principles necessary to secure residency training and become successful podiatrists. Though my experiences, I have learned that the field of surgery involves much more than the technical aspects of “cutting and repairing” tissues. As podiatric students, we must have a thorough understanding of the principles of tissue repair and normal healing so that we can appreciate abnormalities in repair. On top of that, we must also understand the technical factors, which will aid in normal repair, and how to diagnose and treat complications. Lastly, podiatric students must appreciate the protocols required in treating surgical patients in a myriad of settings in today’s rapidly changing healthcare environment.

In our Pod-Med Skills Lab, we get to take a hands-on approach to all the things that we have been learning in our class including: padding for plantar lesions, taping, splinting, treating verrucae, debridement, local anesthetic injections, Doppler ultrasound technique, bio-mechanical evaluations, and casting. I think that it is important to stay focused on the genuine nature of our profession throughout our schooling as to avoid being sucked into the rigors of the basic sciences and I feel that our Pod Med class helps to keep us aware of the bigger picture and ultimate goal at hand. Our rotations through the clinic also adds to this.


After Pod-Med Skills Lab, I will head down to help out as a TA in the cadaver lab where the 1st year students are learning Lower Extremity Anatomy. Each student and their lab partner are responsible for performing their dissections properly in order to learn the anatomy in a practical and tangible setting. The lower anatomy course exams are split into a lecture exam and lab exam so my main focus as a TA is to make sure the 1st year students can relate what they are learning in lecture to the actual structures on the body. Sometimes this means helping with dissections or identifying structures on their body that are difficult to find. This helps me stay sharp on my Lower Anatomy knowledge, which makes up the largest section of our board exams (which I will be taking in July).

podiatric surgery class


After TA-ing, I usually have a Pharmacology or Radiology class.


After classes are over for the day, I’ll spend the next few hours reviewing the day’s material and making flashcards of the most high-yield concepts. If I get that done, I’ll continue studying for boards until about 5:30-6:00pm. Once I reach a good stopping point and all of my daily tasks and goals have been accomplished, I’ll either head to the gym or attend the occasional skills workshops that the various clubs on campus put on. These workshops allow you to explore your interests further, learn new skills, and/or practice ones you’ve already learned. For example, the Surgery club puts on suturing, tendon repair and bone saw workshops.

Around this time of the year, as I leave campus and head for home, the sun will have already set, adding to the fact that the majority of my outdoor exposure in in the dark.


As any medical student with a family knows, it can be extremely difficult to be away from your spouse and kids for so long, so that is why arriving home is the best part of my day. As I walk through the door, I’m welcomed by two very excited kids who want nothing else but for me to pick them up and then play with them or read a book. My amazing wife has already started making dinner and she gives me a hug and a kiss as she asks about my day. I honestly don’t know how she handles both kids all day and does everything that she does for our home and family; she truly is my inspiration. While playing with our kids, I’ll ask our 3-year-old son how his day was and what kinds of things he did and enjoy listening to his numerous stories and adventures. After dinner, the kids take baths and get in their pajamas and we normally head downstairs to play games or watch a movie as a family until bedtime. However small or limited they may seem at times, these are the moments that keep me going throughout the day. Everybody has their “why”, their “why are you doing this”, their reason for striving for success and mine is in the form of these three beautiful people.


After everyone’s in bed, I set an alarm for the morning and lie there reflecting on what needs to be done in the morning and how I’m going to get it done. Sometimes I feel overwhelmed with everything on my plate: my family, classes, my studies, exams and now boards in July. It can be stressful at times but somehow, with the help of my friends and family, I get through it all to move on to the next day. Being a medical student of any kind definitely is not for everyone but I am truly lucky to have such wonderful opportunities and I am grateful for the life that I live. And to think that I get to do it all again in the morning.

medical school family

The Sunday Spin: Avoiding medical school burnout

medical school residency burnout

The Sunday Spin, Episode 8: “Rivers and Roads”

The Self-Titled Debut Album by The Head and the Heart

For context, this week’s Spin is coming directly from the passenger seat of a sports utility vehicle. I’m sitting next to Donny, my childhood buddy, as we roam the Pacific Northwest…

This trek marks an almost four-year anniversary since we first made the journey to Portland, Oregon, catching an impromptu firework display and an energetic performance by a French Electronic-Pop duo called Stereo Total. The trip could not have come at a better time! Scheduled right after my USMLE Step 1 Exam, it was the fun and regenerative excursion I needed. Not only was the trip memorable, but it also generated a fervor for travel deep within my bones.

Prior to our adventure, my vacations had consisted of study binges and family road-trips laden with crisis. By the time I reached college, I would avoid breaks like the plague. I became intimately acquainted with the 24-hour reading room at Shields’ Library, getting “Lost In My Mind” instead of enjoying life…

Don’t get me wrong, I love studying as much as the next “type A” personality, but there comes a point when your productivity tanks and work becomes futile.

How do you avoid this diminishing margin of return and inevitable “burnout?”

Well, you can do what I did and push through it, spiraling further into exhaustion o Or, you can capitalize upon my mistakes and heed this simple advice: “Take time for yourself.”

[Tweet “capitalize upon my mistakes and heed this simple advice: “Take time for yourself.””]

At face value, this seems easy! Of course, I’m going to take care of myself, sleep well, eat right, and exercise… Sure! Let me know how that’s working for you. If you are anything like me (heaven forbid), you find it hard to put yourself before the books and before others. Sadly, as medical professionals, we are faced with endless tasks and demands. And until you learn to let go, you are going to drown in the workload.

Unfortunately, I learned this sad truth rather late in my “academic career”…

I know. It feels selfish to go on an enjoyable vacation or even to take the time to exercise or go shopping instead of studying. Don’t be plexin’ (worrying) because here’s a dirty little secret: unless you skip studying and working altogether, you’re probably going to do just fine!

I’m sure what I am saying is nothing new, we are reminded frequently by our mentors to “Stop and smell the roses.” However, an extra reminder doesn’t hurt…

You have to be proactive about your health and vacations, otherwise “burnout” will creep in like mold on that loaf of sourdough bread sitting on my counter, which my roommate and I are passively avoiding throwing out (little does he know, I once kept a tortilla so long that it looked more like an avocado than compressed flour by the end).

[Tweet “You have to be proactive about your health and vacations, otherwise “burnout” will creep in like mold on that loaf of bread “]

So, get out there and have some fun! Especially those of you on the cusp of taking your USMLE Examinations!

Here is some tune-age to accompany your adventures, courtesy of The Head and the Heart.

medical school burnout

Forged in Seattle, Washington, The Head and the Heart was a conglomeration of transplants that met via local open mic nights. Their songs were simple. Filled with beautiful harmonies tied together by an acoustic guitar, garnished with the tinkling of ivories or swells of violin strings. They cultivated a rustic tone that could only be harvested in the Pacific Northwest or the “Drrrty South.”

The Head and the Heart was quickly be signed to Sub Pop Records after producing the single “Down In The Valley in 2009. The band promoted themselves by selling burned copies of  “Down in the Vally” wrapped in a homemade denim sleeve (much classier than Alice Cooper’s album, School’s Out for Summer, which featured an inner sleeve shaped like panties). Demand for the denim adorned discs outgrew the supply, as The Head and the Heart opened for bands such as Vampire Weekend, Death Cab for Cutie, My Morning Jacket, The Decemberists, and Iron and Wine. And the band would complete their album and release it in 2011.

The Head and the Heart’s debut self-titled album is a masterpiece with songs craftily sewn together, opening brightly with “Cats and Dogs” which abruptly morphs into “Couer d’Alene.” The ebb and flow of energy within this album is incredible.  The melodic drone of “Down in the Valley,” “Rivers and Roads,” and “Heaven Go Easy on Me” juxtapose nicely with pulsating breakdowns that get your toes tappin’ and hands clappin’.

Specifically, “Rivers and Roads” invokes an element of nostalgia that brings me back to medical school. I can’t help but think of my classmates and ponder how they are doing at their respective residencies scattered across the United States.  My favorite single off the album has to be “Lost in My Mind,” a jubilant song of encouragement, reminding us to care for our brethren. An important message, needed now more than ever!

Whether it be raining “Cats and Dogs,” snowing “Down in the Valley,” or sunny along your “Rivers and Roads,” get out there and explore!